Toxic Bosses in Healthcare: A Source of Quality, Safety, and Cost Issues

We have all seen bosses so toxic that their staff have PTSD, exhibit no morale, and develop a hard carapace of coping mechanisms. In this blog, we are going to nominate several high-prevalence types of bad bosses, and for each type, describe how you can diagnose them, what bad outcome typically results from their behavior, and finally, what you might be able to do about it.

Bad outcomes of toxic bosses include demoralized staff, high turnover, low productivity (staff do the minimum and stay under the radar), increased safety and quality issues, law suits, stress and burnout-related health issues. Toxic bosses create a toxic work environment; staff develop unhealthy coping mechanisms to deal with the work (eg, overeating, drinking, gossiping, and finding avoidant ways to fill their day).

Here are six types of toxic bosses that might be unpleasantly familiar to you.

Patronizing Patty

This manager employs a condescending/demeaning approach, tone, or manner in their interactions with their employees. This usually occurs when training on new processes or delivering corrective feedback. This manager often fails at positioning their staff to develop new capacities, and undervalues the importance of grooming staff, perhaps in an attempt to protect their own job.

In working with Patronizing Patty, you will find her engagement with you to be condescending or demeaning. Although patronizing behavior can occur during many different types of interactions, they are most noticeable when the individual is delivering corrective feedback, or working with staff they believe to be problematic.

Because of this type of behavior, staff under Patronizing Patty tend to employ avoidance tactics, or pursue guidance from other authority figures to limit interactions with this manager.

Depending on the organization and the support it provides for staff, staff may resort to reaching out to senior leadership to inform them of the issue, or to secure a resolution. Resolutions may include 1) reassignment under a new manager, or 2) corrective actions executed by the manager’s supervisor or an external facilitator.

Michael the Micromanager

The manager who is overly prescriptive and gives excessive supervision. This boss is most likely to have been promoted too fast, and feel they know the job better than their staff. Micromanagers are incapable of seeing this in themselves – they think they are just “detail oriented.”

In working with Michael the Micromanager, you will notice that they are overly prescriptive in how they would like to see things done and like to provide excessive oversight. Micromanagers will delegate tasks to staff but will involve themselves in every step and decision.

This management style often results in unhappy, resentful staff, which in turn may translate to high turnover. A major downside for the organization is that the micromanager does not allow for original thoughts or creativity since employees are only seen as successful if they emulate the boss.

Staff working with a micromanager may choose to mitigate by setting up a recurring meeting in which they provide extremely detailed updates of their progress. Further, staff may choose to provide more frequent updates (e.g. daily) to provide an update before the manager has an opportunity to request additional updates. The voluntary information transfer tends to contain the micromanager, and staff may try loading the manager up with copious information to keep them busy.

Rigid Ronnie

The manager who is wedded to a particular approach or specific principles to complete work.

In working with Rigid Ronnie, you will notice their keenness for specific approaches to conducting business. They often fail to embrace innovation and emerging practices; and tend to respond to proposals with comments such as “but this is how we’ve always done it and it works.”

Because of this rigidity, staff tend to abandon their imaginative approaches to the work. Instead, they dedicate a significant amount of time learning to do things according to their manager’s preferences. Staff often feel their unique experiences and strengths aren’t valued given their inability to apply them to the work.

Staff have to determine how important it is to them to affect change in a rigid environment. If their creative license is of paramount importance to them, they should consider seeking employment that favors this attribute. If their short or long-term goals can be achieved under Rigid Ronnie, they may consider sitting tight long enough to realize those goals before deciding to transition away.

Fancy the Favoritizer

The manager who tends to favor certain staff and only communicates with the staff they like most. This manager often engages their favorites more than other staff and tends to keep this group of staff more informed than others.

In working with Fancy the Favoritizer, you will notice the manager’s pets. This preference is often observed in the opportunities (i.e. information sharing, professional development, promotion) they make available for their “favorites.” In addition, these managers often seek to work closely with their favorites.

Favoritism in the workplace can result in those less fancied feeling disadvantaged and slighted. These sentiments often translate to a feeling of distrust for the manager and or their “favorites.” When the favoritism is related to gender, age, race, etc. this may result in costly and disruptive legal action.

Frank discussion may change Fancy’s behavior, but it may be necessary to bring in a facilitator or have the manager attend appropriate training and counseling.

Bill the Bully

This is in the top two of bad bosses; this boss is so insecure that he manages by intimidation and threats. He uses tactics like yelling at staff in public, putting staff down, and using threats. Billy’s bad behavior is obvious to his staff but is often invisible to his superiors.

Billy often displays signs of pathology in his dealing with staff in the form of transferred anger, contradictory messages, and over-reaction.

Employees subjected to Billy over time may become numb to the continual abuse. Others flee at the first chance, thus high rates of turnover and absenteeism.

As bullies are rarely confronted by their employees or even their colleagues, these bosses unfortunately may remain in their roles for long periods. A change in leadership or a legal complaint is sometimes the only way out for these tortured employees.

Connie the Non-Communicator

We all know that effective communication is the key to all good relationships. But what is to be done in a work environment where the leader fails to communicate with the staff that are responsible for the work?

In working with Connie the Non-Communicator over time, you will notice their failure to communicate pertinent information (eg, expectations, strategic direction, short and long-term goals, organization/program/project changes). Usually, the lack of communication isn’t intentional but rather, because of the manager’s 1) perceived value of timely communication 2) belief that information is being disseminated through other chains of communication, and 3) misguided belief about what information needs to be shared.

Lack of communication results in staff feeling insecure about the status of affairs, uninformed, in the dark, and without direction. Staff tend to rely on one another to construct a full picture of what is happening within their unit, and when available, seek the counsel of and direction from other managers willing to provide the missing insight.

Staff may organize and agree on what their communication needs are and discuss/share them with their manager. In doing this, they should emphasize the value of communication and provide examples of how being well informed improves staff morale, performance, and productivity.

In a future blog, we may cover some other species of toxic boss, including “Sammy Softie” and “Ivan Inappropriate.” Sammy is lovable and affable but won’t make decisions or stand up for staff. Staff feel powerless and unmanaged even though they love the boss to bits. Ivan Inappropriate has romantic off duty personal relationships with staff and often sends horrifically inappropriate texts, etc.

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What is the impact on patients? In a Healthcare setting it is often the patients that suffers the most. Is it possible to put these toxic Bosses on a Spectrum? If so, which boss is yields more harm to the patient?